Germ cell tumor pathophysiology

• Germ cells are the cells that develop in the embryo and become they make up the reproductive system in males and females.
• After the development of germ cells, they follow the body midline path and descend into the pelvis as ovarian cells or into the scrotal sac as testicular cells.
• Th ovaries and testes are called gonads and many ovarian and testicular tumors have germ cell origin.
• The pathophysiology of germ cell tumors is different based on the classification of germ cell tumors
• Each of the distinct entities of germ cell tumor has a different pathogenesis
• Germ cell tumors are classified as;
  • Gonadal
    • Seminoma
    • Dysgerminoma
    • Germinoma
  • Extragonadal
    • Embryonic
      • Mature/Immature teratoma
    • Extraembryonic
      • Chorio carcinoma/Yolk sac tumor
        

Testicular Seminoma

• Accounts for about a third of all testicular germ cell malignancies and is one of the most treatable cancers with a survival rate of 98% to 99% in early-stage disease
• originates in the germinal epithelium of the seminiferous tubules as a result from the proliferation of immature spermatogonia   
• On gross pathology, seminoma is characterized by pale gray to yellow nodules that are uniform or slightly lobulated and often bulge from the cut surface.
• Microscopic Pathology:
  • On microscopic pathology, seminoma is characterized by

  • Cells with fried egg appearance - key feature

  • Clear cytoplasm
  • Central nucleus, with prominent nucleolus. Nucleus may have "corners", i.e. it is not round.

  • Lymphocytes - interspersed (common)
  • Syncytiotrophoblasts, present in 10-20% of seminoma

  • Large, irregular, vesicular nuclei
  • Eosinophilic vacuolated cytoplasm (contains hCG)

  • Florid granulomatous reaction

  • Approximately 24% of Stage I seminomas have lymphovascular invasion for stage I (Tx, N0, M0).
  • Intertubular seminoma may not form a discrete mass and mimic a benign testis.

Dysgerminoma

The pathophysiology of ovarian germ cell tumors depends on the histological subtype. Their common origin is believed to be from the primordial germ cells that transformed pathologically in different stages of development. It is difficult to distinguish subtypes of ovarian germ cell tumor on gross pathology alone. The majority of ovarian germ cell tumors have a solid and cysticappearance with areas of hemorrhage and necrosis. On microscopic pathology, ovarian germ cell tumors may be characterized by a uniform “fried egg” appearance (dysgerminoma), presence of Schiller-Duval bodies (yolk sac tumor), presence of embryonic-like neural, gastrointestinal, and/or cartilaginous tissue (teratoma), or mixed histopathological features (embryonal cell carcinoma).